Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Internal Medicine


Dr. Watkins, DHSc, MPAS, PA-C


Type 2 diabetes (T2D) is one of the most common and costly chronic diseases faced worldwide, and is a significant problem in the United States (U.S.).1 According to the CDC, in 2015, 30.3 million Americans had diabetes.2 Another 84.1 million had prediabetes, a condition that usually leads to T2D within five years.2 The total estimated cost of T2D in 2017 was $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity.3 How do we win the war against T2D? We must focus on the importance of screening and prevention. Over 90% of people in the U.S. with prediabetes remain undetected. Prediabetes is associated with the simultaneous presence of insulin resistance and beta cell dysfunction, abnormalities that start before glucose changes are detectable.4 Observational evidence shows associations of prediabetes with early forms of nephropathy, chronic kidney disease, neuropathy, diabetic retinopathy, and increased risk of macrovascular disease.4 Prediabetes, or impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG), puts one at higher risk for developing T2D.5 Recognizing high-risk people is mandatory but the question arises on how to recognize normal people who are at risk for T2D in their future. The oral glucose tolerance test (OGTT) has been the mainstay for diagnosing diabetes for decades, but the U.S. has gotten away from it as a screening tool. With earlier detection of impaired fasting glucose and impaired glucose tolerance by using the OGTT for screening, the burden of T2D in the U.S. will be significantly reduced. Earlier detection in the dysfunction of glucose metabolism will identify those who are already on the path to diabetes, and will allow for earlier interventions, which will improve the morbidity and mortality of lives long term and will save billions of dollars lost in the treatment of T2D.


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